Spontaneous internal carotid artery dissection with lower cranial nerve palsy

Background. Typical presentation of spontaneous internal carotid artery (IC A) dissection is an ipsilateral pain in neck and face with Homer's syndrome and contralateral deficits. Although rare, lower cranial nerve palsy have been reported in association with an ipsilateral spontaneous ICA dissection . Case studies: We report three new cases of ICA dissection with lower cran ial nerve palsies. Results: The first symtom to appear was headache in all three patients. Examination disclosed a Homer's syndrome in two cases (I an d 2), an isolated XIIth nerve palsy in two patients (case 1 and 3) and IX, X, and XIIth nerve palsies (case 2) revealing an ipsilateral carotid dissec tion, confirmed by MRI and angiography. In all cases, prognosis was good af ter a few weeks. Conclusions: These cases, analysed with those in the liter ature, led us to discuss two possible mechanisms: direct compression of cra nial nerves by a subadventitial haematoma in the parapharyngeal. space or i schemic palsy by compression of the ascending pharyngeal artery.